Hypothalamic amenorrhea #1

This post is not intended as medical advice and I am not an expert. I write this with lived experience, the intention of raising awareness and promoting self advocacy.

Have you lost your period?

Losing your period is never something that should be taken lightly, it can be a serious indicator that your body is functioning suboptimally.

What is Hypothalamic Amenorrhea?

The absence of a period for 3 or more months related to an problem with the hypothalamus. The hypothalamus is situated in the brain it connects our endocrine system to our central nervous system. It has many roles- it basically acts as a regulator for many of our bodies systems. It is the main regulator of the pituitary gland which is the where central regulating hormones are released. Some of those hormones include reproductive hormones, needed for menstruation.

Hypothalamic amenorrhea- When the control centre of the brain that regulates hormone secretion– is turned off.

Why does this happen?

There are several factors that can lead to disruption to the hypothalamic signalling. This post is focusing on the reproductive aspects- hypothalamic amenorrhea. My intention is to give a brief outline to help you understand 1.why it happens, 2. Why doctors don’t necessarily consider it when they see someone in front of them.

Factors that lead to HA:

Energy deficit, this is the biggest factor and can occur due to a plethora of reasons. One of those is dieting. Whether this is through intermittent fasting- where the regular signals are not being maintained, caloric deficit, or excluding specific food groups such as cutting carbs/ fats, they all disrupt the signalling from the hypothalamus.

◦ If your hypothalamus perceives energy deficit it shuts down non vital functions of the body. It keeps you alive, it’s like a book balancer. What you don’t “need” it cuts. Menstruation is a function of reproductive health. Therefore, it is not a vital component to staying alive. Therefore it shuts off this non vital function, in order to preserve other functions including keeping your heart beating. This is another reason why we tend to feel COLD ALL the time when we are in energy deficit or have HA- the generator shuts off the heater to conserve other functions.

Weight loss regardless of your size. You can have HA at any BMI. Firstly, If you lose weight it’s likely related to energy deficit, however when you lose weight you lose important regulating hormones (leptin) which are in fat cells and this is part of the feedback system to the hypothalamus.

Stress. Something that puts stress on your body can disrupt periods. This may be through emotional or physical stress. Cortisol turns off the hypothalamus. Therefore it can cause you to lose your period.

◦ For similar reasons to above- exercise especially high intensity exercise can raise your cortisol by placing stress on your body. Additionally it can lead to energy deficit and weight loss and so it’s continues the issue. This is part of “female athlete triad”

Unfortunately HA is a common issue, however it’s not always recognized. Partly because it’s not understood and there are many misconceptions around HA. For instance people inhabiting in larger bodies are often rewarded for their weight loss efforts and exercising, but we know that HA can occur at any size. But often we are not as open with healthcare professionals about our lifestyle and they often don’t enquire.

When women lose their periods they are sometimes then commenced on the contraceptive pill to “restart” their cycle, or in some instances diagnosed with Polycystic ovarian syndrome (PCOS).

Unfortunately this is a problem because the management of PCOS- is often the complete opposite of HA. The contraceptive pill does not address the underlying issue, energy deficit. A bleed induced by the oral contraceptive pill is not a real period. If you took the pill away likely the person would not bleed.

I lost my period for a long time, thankfully I have healed from HA personally.

When in the depths of my eating disorder I did not advocate for myself or share my situation with healthcare professionals. I was advised at times to take hormones, I was not advised to stop/ reduce my exercise or eat more for instance. Getting a diagnosis is challenging because one, we don’t share and two it’s not always on the healthcare professionals radar.

However sharing knowledge with health professionals can help raise awareness.

I am no expert, I write this purely from personal experience and getting to know people within the recovery community.

I encourage anyone who has lost their period to seek medical advice, there are many reasons for this not just HA. But if you are someone who could be at risk of this you may need to advocate for yourself here.

I’ll write a separate post about some of the myths and issues associated to HA.

Giving less F*cks

Giving less f*cks has been very important in my recovery. I feel giving less f*cks is liberating.

I do not mean, I don’t care about anything. Far from. I have learned that giving too many f*cks is part of my problem. So learning what to get rid of in my giving a f*ck bucket has been energy freeing. Freeing up the genuine give a “f*cks” like my family, friends, career, running, sketching, my cat, helping others.

I care a lot about my job, my career and everything it represents. However my profession is a breeding ground for perfectionism and comparison. Both things I have had to work very hard at challenging for my eating disorder recovery. Right now recovering from my eating disorder is priority so that my future self can be my best version in all areas of my life including my career. That has meant some things I have given too many f*cks about previously I simply cannot afford to anymore.

As part of my core values and self worth it is important to me to work hard, be good at what I do. But how that’s defined does not have to rely on single peer comments or being aware of every statistic from every journal ever. It comes from so much more holistically.

Another thing I have found to help me in recovery is to “let go of comparison”

There is a popular phrase, “compare and despair” which I believe is very relatable.

I believe it is innate in us all to compare ourselves to our peers. But what we compare is what I believe causes us harm and dis-regulation. It can come at a huge detriment in recovery.

Body comparison is common and meaningless. For instance, I recall early on in my recovery my therapist at the time challenging this very process. I used to compare my body to other people’s bodies all the time. She explained, that we carry biases. We tend to only see what our brain filters and we have a very selective attention. Therefore I remember one of my challenges was to walk through a crowded street, take notice of the diversity. Sure enough we all come in many shapes and sizes and our appearance is irrelevant.

This exercise made this particular comparison easier to stop. Knowing the bias I harboured meant I could be accountable and when I found myself comparing, I could call myself out on it. Additionally challenging why I was trying to compare. Realising that what you see externally does not translate to what’s beneath the surface and so we are comparing to a false ideal we have created. How do we know the richer, slimmer person is any happier than ourselves.

Your eating disorder will never tell you you are as good as the person you are comparing to. Importantly, why would we want to be anyone other than ourselves?

Getting out of other people’s business..

I had a massive problem with comparing what I was eating to what everyone else was eating. I was in everyone’s business. But just as what I am eating is no body else’s business, it is of no relevance to me what anyone else is eating. I no longer could tell you what every single person at a social gathering did or didn’t eat because it doesn’t matter!!!

Comparing your eating disorder to someone else’s, completely futile and not comparable even within the same diagnostic label. Comparing others’ recovery and feeling you’re doing it wrong or not as deserving or vice versa. Just stop it, this is the eating disorder. Your recovery is your own. Your body is your own with it’s own requirements. Letting go of this has made recovery much more free.

There are many situations we can find ourselves drawing comparisons, status, aesthetics, character traits, possessions, families, sporting prowess, holidays, weddings, education, careers the list is endless when you think about it. It’s problematic when it’s black and white and impacts upon our thinking style. I’m not saying you will never compare yourself to someone again, I believe it’s ingrained in us all from an evolutional perspective, where historically it would have been a survival advantage. However there are ways I have learnt to lessen the unhelpful comparisons.

We live in a competitive society

We are told on a daily basis on many platforms to be the “healthiest’, richest, most successful. Women are made to compare themselves to other women constantly. It’s all external measures and rewards. Competition can be healthy, but recognising when it’s a problem is important.

For me, as long as I know am performing at my best, whether it’s at work or any other aspect of my life, I do not need to compare myself to my peers.

I know when I’m doing ok in this, because I don’t feel like I’m constantly striving and never achieving, I can feel grateful in little wins. This is not the case when perfectionism is in the foreground and unhealthy competition, then I never feel satisfied or recognise achievements big or small.

Gratitude:

Practising daily gratitude has really helped with this mindset shift. Seeing celebrations in the small things, there is something to be grateful every day, even on days where it’s hard to feel gratitude. This helps me filter my ‘Give a f*ck bucket”.

In my profession, I am yet to meet someone who in their final moments, talks about how much money they made, or how gorgeous they were in their youth. No they always talk about what matters, family, friendships and experiences.

Stop basing how you see yourself by comparing yourself to others. One thing is guaranteed is there will ALWAYS be someone who appears to be ranking better than you on some standard. You are good enough just as you.

Feel free to share

Health professionals are clueless around weight stigma…

Healthcare professionals are not infallible and have their own biases

Apologies in advance for probably a relatively ranty post.

I am not considered overweight, I have been at the complete opposite end of the spectrum and have been often rewarded by health care professionals for being “healthy” when I was slowly killing myself.

When I was considered emaciated this positive reinforcement shifted, I met a lot of stigma from healthcare professionals.

Today I have just experienced horrific weight bias whilst at a medical appointment. A nurse who had my medical record on screen, open in front of us displaying my history: Anorexia nervosa.

Whilst I sat there she began to discuss how next week brings the onslaught of patients booking in for weight maintenance, counselling after “over indulging in the holidays”. She was clearly ignoring this history. She continued with her opinions and judgements regarding patients eating “bad foods” and expecting to lose weight.

My response was somewhat blunt, probably rude. I wish I was brave enough to point out my history but instead I shared my very anti-diet views. Explaining I do not believe in the multi million dollar industry that promotes dieting. I explained if there was a diet that genuinely worked the industry would not be in business. If people successfully reach their goals and stayed there there would be no diet industry. But I explained that simply doesn’t happen and leads to obesity. She went on to demonise foods. To me.

She started talking about a group of people who exercise every day “and aren’t overweight” and do not lose weight. She stated it’s because they aren’t dieting with it. “You can’t do one and not the other” if you cut out rubbish you will easily lose weight she went on to express. She told me how cutting out “unhealthy food, sugar” it’s easy to lose weight.

At this point I was like, are you fucking serious. You’re sat telling a patient in recovery from anorexia about losing weight and demonising foods and promoting the idea that weight gain is to be feared by anyone.

Again, I wish I had felt stronger to call her out. But there’s still a part of me that can’t quite do this in an non anonymous setting. I will get there.

It got me thinking and really feeling for patients. If someone with a history of anorexia, not that long in recovery and not overweight can be subjected to this. Then people who are considered “over weight” according to a BULLSHIT MEDICAL INDEX scale, aka BMI then this is horrendous. We are terrible in the health industry and really under educated in this area. This is one of the reasons I started this blog. To educate and reduce biases in health, society and reduce stigma.

Stigma does occur in very low weight too. When I was very unwell, doctors told me I was irresponsible, like it was a choice. I was marched across busy waiting rooms and made to step on the scales in front of audiences and then condemned publically if I’d lost weight or not gained. I remember one occasion being made to walk up and down a corridor (waiting area) by a GP to make sure my heart wasn’t failing, and saying aloud if you don’t put on weight by the next review you will be forced to be admitted. This is fucking awful when I think about it now.

Scales can be terrifying to someone with an eating disorder ( or no eating disorder)

If you are a healthcare professional: keep your own biases and fear of weight gain to yourself.

If you are knowingly looking after someone with an eating disorder it is highly inappropriate to make them step on scales with an audience, if you must weigh someone keep it neutral without judgment. Scales are one of the scariest things you can ever imagine for someone with an eating disorder, underweight or overweight. In my opinion scales in a hospital or doctors should not be in a public area.

If you have ever experienced stigma, judgement by a healthcare professional I am truly sorry. One day I hope we can shift the narrative. If you feel brave enough and you find yourself in a similar situation to that of mine today, please speak up. I promise I will try to myself next time.

Social media and eating disorders…

Social media is part of our every day life.

For some people their work relies upon social media. It has so many roles and uses in today’s society.

Social media can be helpful to us in our recovery, but it can be a minefield. I actually removed myself from most social media accounts early in my recovery. I don’t believe there is a right or wrong solution to this, but I believe an awareness of the impact social media has on you personally and whether it is helpful or detrimental in your recovery is the most important question. Your motives for following particular accounts, whether they serve you, or your eating disorder.

If you look for it, there are tons of recovery orientated social media platforms. But, it’s not always easy early on to identify motives of some and whether they are 100% pro-recovery.

Some platforms, target our vulnerability. Ads, pop ups etc all follow your history and if you are trying to move away from certain paridigms it can be really hard being constantly reminded about the latest fad-diet or exercise programmes etc! You get my point. Equally you can’t control what people post/ talk about. Your friends, family and colleagues may post things that are particularly sensitive for you. So sometimes taking some time away from this can help at least until you are in a stronger place.

Social media can be anxiety provoking, for those in lockdowns, isolation the conflicting and unhelpful messages can impact upon mental health. It’s not surprising around the world the new diagnoses or relapses of eating disorders that have occurred during the pandemic. Social media I believe plays a large part in this. Adding to pressure around health, diet and exercise. As well as the change to routine and access to normal resources. Knowing that not everything on social media is real, or as it appears on there I think can help.

I am glad I didn’t grow up in the ‘Tik-Tok’ era, and facebook/ instagram was only really around when I was late teens. I feel for teens and young people now with the pressures of social media. This really worries me for future of their health.

It’s the time of year where the diet and fitness industry try their hardest to sell their products. So social media is swamped with diet culture and all the shit that goes with it. I am now in a place where I can mostly see this for what it is, selling a product. This industry generally targets a vulnerable population too, people like myself. However I am aware of it, and I’m aware of the impact it can have on me. I will not be deleting my social media accounts this year. Last year I needed to, to escape this onslaught. Instead I am using my social media to promote the ‘fuck it diet attitude’, following positive influences that are pro-recovery. If an ad pops up, I will simply reject it. Friends, family and colleagues dieting that’s up to them, I can choose to ignore this. But if you are in a place where this is going to be damaging to your recovery, a social media holiday can help. I found it quite liberating and realised how reliant upon social media we are. Returning to social media has been a big test in my recovery.

Shifting the narrative in eating disorder recovery….

Recovery is millions of little challenges

My husband and I were hiking yesterday. We had hours of trail ahead and in between goofing around, talking about our plans for the week ahead we talked about the last year, 18months. So much has happened in this time, like for many people. We talked about people missed. Career paths, life plans and we made jokes about previous events. One event, now an often feature of his jovial mockery and light hearted goading is one of our darkest moments. Often making a situation that was once very unfunny can flip it on its head, make it more bearable. You see that a lot in the healthcare setting, jokes that someone from a non healthcare background would shudder at, is often daily practice. Why? because it makes pain and darkness more bearable and shareable.

This situation we were joking about was one of my biggest meltdowns, i’ve ever had. We were in New York exactly a year ago. I wasn’t really in recovery at this point, although I was fooling myself I was. We had been taking in sights all day, darting all over the place. I had done, what I did a lot at this time. Bargained with myself. I was “allowed” to eat whatever I wanted in the evening because I had been so active during the day. Fucked up beyond all reasoning, but this is how the eating disorder often works. Often that bargaining never actually leads to “eating whatever you want’ but we were looking for a restaurant that would suit us both. I didn’t have much input in restaurants at this point, so it was usually down to my husband to select somewhere. He talks about how incredibly stressful this was. I have no doubt, it must have felt like he was checking for poison for some medieval royalty. I would quash most selections before they had left his lips. However this particular day, it was 1 week from Christmas, we hadn’t booked. So the stress for him was ridiculous. Before he found a place, we spent an hour with us scanning menus, me rejecting. It got to the point where we retraced our steps and chose one at random that would allow us without a reservation. What came next, I don’t really remember. But he does very clearly.

It was a steak & lobster restaurant. There were no other options. There were chips and meat. That was it. After looking at the menu for all of 30 seconds, I burst into full blown tears, sobbing in a packed restaurant. I cannot describe what was going through my mind at this point. Except it was like the world had just ended. I had built the meal up, I was going to eat. Then I was presented with two things I hate, red meat and shellfish. I was petrified of chips at this point. A menu had reduced a 30 something to full blown tears. Inconsolable, snotty ugly tears. We stayed. ‘HH’ screamed that my opportunity had been ruined bla bla. I struggled through the dinner eating chips. Both of us shocked at how irrational I was. I had had moments like this at home but this was in the middle of New York. It’s obvious now, this was plain and simple fear.

But whilst cringing at this event, we chatted about the narrative now.

Eating disorders are not rational.

My world didn’t end. I didn’t die. I just looked totally mental. Now after lots and lots of little moments, challenges, meltdowns I can laugh at how absurd this moment was.

The point of this, recovery doesn’t happen over night. Recovery isn’t a case of going to bed one night and waking up recovered. It’s full of obstacles and challenges. If it’s not challenging it’s probably not recovery and doing jack shit.

Today, he asked me if I wanted an Ice cream. I heard myself say ‘no thanks’. This is a response ‘HH’ has trained to become my default. I am changing this narrative to ‘Yes, please’. Some days yes please is easier than others. But it felt uncomfortable, spontaneously having an ice cream. ‘HH’ certainly did not approve. This is another moment, challenge towards recovery. It was a world apart to the lobster joint. I felt uncomfortable, I got on with it and used to distraction techniques I’ve learnt along the way after. ( Today was repotting some of my veggies, other times breathing techniques can help) But if I’d said no thanks, it would have been a missed opportunity. Without challenges, nothing changes. In recovery discomfort is action. I don’t think I would sob in a restaurant now, unless the world genuinely was ending. I don’t bargain with ‘HH’ any more. There is no bargaining with an eating disorder, that’s an argument you won’t win unless you decide to do the complete opposite of what it’s telling you.

Useful breathing technique: https://www.cci.health.wa.gov.au/-/media/CCI/Mental-Health-Professionals/Anxiety/Anxiety—Information-Sheets/Anxiety-Information-Sheet—08—Breathing-Retraining.pdf

Food is more than just food.

Best biscuit ever……

Yesterday, I had a strange realisation. It’s taken me almost 30 years to get to it, but yesterday I realised food is not just fuel. Food has no rules, no moral value and no foods can be ‘good’ or ‘bad’.

Whilst reflecting about my relationship with food, I craved a chocolate Hobnob. I heard ‘HH’ stipulate, ‘but you’re not hungry’. It was this thought, I rewound and re-framed my life-time’s thinking. Food, although important for fuel and nutrition is also part of connection and ENJOYMENT. It’s always blown my mind that people have just been able to easily eat something, just because. But yesterday, I understood food can be eaten whenever. Whether we are hungry or not. If we want to eat something we can, without judgement, without compensating, because it’s just food.

I was feeling particularly reflective yesterday, because I felt really fucking sad. The fact the I felt sad, set off a whole chain of thoughts. But what made me grateful amongst it all, the fact I could acknowledge and identify that emotion. For years I have numbed my emotions, to the extent when I started to feel again, it took me a while to recognise what I felt. That’s pretty common I think amongst us who have eating disorders. I no longer associate with the nickname I have had for years and use to value, ‘the ice queen’. This is not me now. Nor do I want it to be. The fact it became at one with my identity is quite disturbing to me now, as I am a compassionate person. But in the depths of ‘HH’s grips I was an emotional void. I’d get angry, anxious & irritable if my routine was disturbed, or challenged but these were pretty much the extent of my emotions. Instead of returning to my old behaviours yesterday, exercising to the point of exhaustion, pain or restricting to the point of false euphoria, to numb out the events. Instead I went for a walk out in nature listening to a podcast and then had a cup of tea with a Hobnob.

I felt grateful. Grateful I have reached a point of mental freedom to enable me to feel. Being numb is not living. I was grateful I could feel sadness and sit with it. Feelings pass and are not permanent. But eating disorders are. Recovery although hard, is also temporary.

The next thing I’m working hard to reach, is body neutrality. There is so much talk about ‘body positivity’ at present. I believe the premise of this is great, but I also feel it’s a double edged sword. It’s general concept to love and accept your body, sure. Promoting acceptance by society of shape, size, gender or race is the main aim. But, I feel there’s pressure with ‘body positivity’ as a concept. It over values of the body image itself, rather than appreciation of the body’s functions. For me, I don’t know if I’ll ever ‘love my body’ but I love the things my body enables me to do. I think very few people eating disorder or no eating disorder love their bodies. So for me, getting to a point where I do not care, or have any value from my appearance will be sufficient, beyond that a bonus. But I feel it’s healthier to see our bodies as a vessel, a vessel that allows us to do what we desire. It does not matter what that vessel looks like. That’s what I believe the social media message should be, that’s what body positivity should be.

Interestingly my ‘negative body image’ didn’t truly start until I was in the depths of my eating disorder. Sure there were things I had insecurities with, but I think most people on this planet do have hang ups. But I can say, the negative body image spiralled and it took so much value. This value is incongruent with my own true values, i’m not a shallow person, I couldn’t give a rat’s arse what someone looks like if they are a good human being. But the world becomes so small, consuming and out of alignment with our own beliefs. I really struggle with this aspect of my eating disorder, because on a bad ‘body image’ day it still has far too much space. Space that’s not relevant or part of me. However this is part of the divorce from diet culture and unlearning so many untruths that are so engrained in society. Most days now fortunately I am neutral towards my body, but i’m not where I want to be yet. I’m not where I want the whole of society to be, where body image is as relevant as yesterday’s weather. But rejecting diet culture and accepting ourselves is a start towards remodelling society’s beliefs . Ultimately change starts with yourself.

‘Portion sizes’, re-learning to eat like a ‘normal human-being’, anorexia recovery..

Re-learning ‘normal eating’ ED Recovery

I say normal, loosely. Because the majority of the population has some form of low grade restriction going on. Whether they realize it or not, any diet behavior is restriction. This is not normal eating. But it is ‘societies normal’ This is not an option for us.

When we restrict, our body adapts, by lowering metabolism and a whole heap of other changes like disrupting hunger cues. (This is partly why diets don’t work, restriction leads to a response known as ‘hyperphagia’ (increased hunger) to counteract this unnatural behaviour. Our bodies function in equilibrium and so will adapt or correct the perceived famine. For anyone who is interested like me, in evidence or scientific explanations, the ‘Minnesota Starvation experiment, led by Ancel Keys’ is the closest we will ever get to depicting what happens to humans when starved, both physiologically and psychologically. It would never pass an ethics committee today but the evidence still stands. This was a practice changing study from the forties that still helps to shape nutritional rehabilitation. It provides explanation for experiences such as hyperphagia.

In early recovery most of us experience “extreme hunger”, hyperphagia. For me this wasn’t so much physical hunger, for the most part, but it translated more as mental hunger or feeling off. Regardless it’s still hunger, if we are obsessing about food it’s because our bodies are needing fuel. I was constantly thinking about food, when I was next going to eat, what I could eat, worrying about whether it was ok/ not enough, even dreaming about food, obsessing about food, reading recipes the list goes on. It felt relentless and really intrusive. It was hard to think about anything else. During this period, I would also find it hard to leave food on my plate, even if I felt full, I guess it was my brain freaking out, fearing that I was going to return to a state of famine again. I’d feel almost a compulsion to finish everything. I never felt satisfied early on, I would be painfully full but still thinking about food. This has gotten better with time. I don’t feel the need to finish everything in front of me. This obsession with food was different to that in the depths of my eating disorder, where I would obsess over food then. When under the grip of ‘HH’ I would control everything around it, I’d cook for others, but never eat what I’d made. I’d bake a lot at this point, now I bake if it’s someone’s birthday, I’m just not interested or obsessed like I was. This is common I think, now we have a rule in my house if I make it, I eat it. Some days, if I haven’t eaten quite enough, I find my extreme hunger can return the next day, but this is getting less and less.

This is terrifying when it first happens. If it is happening to you, or someone you know, extreme hunger is normal, it’s a healthy response to energy deficit and reintroducing nutrition. It showed up for me months later in recovery, after I got back on track from a relapse. I didn’t experience it prior. Bingeing is normal in this setting. It’s distressing, it feels it’s going against everything the eating disorder believes. But the only way I found it improved was to listen and respond to it. Restriction remains the enemy for this.

Some-thing I still find difficult, is what’s normal. I also think, there probably isn’t actually a normal, because what’s normal for one person is not for another. However serving sizes is a tricky one, I can under-eat some times because I have done so for so long and my perception of what a ‘normal portion’ is warped.

I have found asking for help with this, although humiliating as an adult and at time unbearably uncomfortable, I often run my lunches past my husband and if he tells me it’s not enough, I don’t argue, I add more. I am trying to re-learn normal eating.

Another thing that helped me, although at the time I hated it and argued until I was blue in the face was relinquishing control around food. By this I mean, I was lucky my partner took complete control of what I ate, when I could not make healthy decisions geared towards recovery without ‘HH’ sabotaging. I was not allowed to cook, prepare meals, or enter the kitchen when meals were being prepared. It was one of the most humiliating experiences of my life and there were times when I would argue, shout, cry, throw, he would force me to eat what was in front of me. I was like a child. But worse, I was an adult having a meltdown. But this role was necessary for a short time, because if left alone, I would skip ingredients, make smaller meals, substitute ingredients ‘for healthier’ alternatives etc.

But it was important for me to regain independence quickly (for me and my partner) and the only way I could was to suck it up.

I cannot express the grattitude I have for my partner, I think people who support a person through eating disorder recovery are saints, they see the worst side of a person imaginable, because a caged animal will always lash out. I have apologised more times than I wish I’d ever have to in a life time. I think this is where it’s useful to seperate the person from their eating disorder. We are not our eating disorders, and the non-negotiations are with the eating disorder, not the person being over shadowed by it. This does not give a free pass to be a dick, it’s just to help understand why you have to keep fighting for recovery. Thankfully this wasn’t needed for long.

For a short while, I followed the principles from Gwyneth Olwyns, homeodynamic recovery. I like evidence and this is evidence based. I will link this below. I do not count calories and find doing so to be detrimental, however this principle sets minimums and it helped me for a short period when trying to become independent again.

One thing I’ve accepted is, comparing what we need to eat in recovery to someone who has not just waged war on there body is never going to be helpful. We need more than most people to heal. Healing doesn’t end at ‘weight restoration’, we still have a nutritional rehabilitation, inner repair, mental healing beyond this. Who knows how long this will take. This, Is hard for someone with a restrictive eating disorder, but I believe it’s true and giving yourself permission to eat whatever, whenever and often ‘more’ than people around you is an important step. Letting go of the judgment. I’ve only recently gotten to this point, I used to find it really really hard to eat in front of, or with others. That’s isolating and something a lot of us have to overcome. So ignoring comments about food is important, hard but totally achievable.

1. The Minnesota Starvation experiment: https://archive.wphna.org/wp-content/uploads/2016/01/2005-Mad-Science-Museum-Ancel-Keys-Starvation.pdf

2. Gwyneth Olwyn, Homeodynamic Recovery Method: https://edinstitute.org/blog/2013/3/31/homeodynamic-recovery-method-guidelines-overview

Navigating recovery…recovery beyond Eating disorder “treatment”

Navigating anorexia recovery

I believe there are many milestones in eating disorder recovery. For starters the first day of entering recovery, this is always going to be the biggest. Monumental. Then after that there are thousands of milestones (some more like marathon check-points). Like the first time we conquer a fear food, and then reach the check point of there not being fear foods. So many. Getting your first period (if you lost it/never had), then its recurrence becoming so normal and boring and moaning about it like the general population. But what about when ‘our formal support’ becomes less required?

For those of us fortunate enough to have quidance, follow a treatment plan or having a coach etc, maybe it helps path the way. But, regardless for the most part, your recovery belongs to you. Own it!

I graduated from “regular recovery support” today. Feel like I have my big girl pants (pun very much intended). I have completed CBT-E, MANTRA and have now reached a point with my therapist (OT) to move to “check-ins” rather than scheduled, regular sessions or following some kind of plan.

I know for some people navigating the world beyond regular support, is scary and daunting. I get it, it means YOU are accountable for the ongoing recovery process. But that’s pretty cool right? You have gotten far enough into recovery to be able to make healthy decisions for your recovery. You’re moving towards full recovery and this is another check-point smashed!! That’s the way I’m viewing it. Part of recovery is learning to “cope” in an informal way, that’s life.

Just because my ‘regular’ sessions are finished does not mean I can’t continue growing my support network or learning. One of the things I’ve recently found to be instrumental to my mental shift is connecting with others who have had similar struggles, are struggling or recovered. There is tons of support, whether it’s real connection, following people’s blogs, podcasts or joining a support group, they all help to validate how we feel and strengthen our healthy self. So I’m not nervous about not having regular appointments. I’m proud I’ve gotten here. I’m grateful. If I can get here, I believe anyone can, because I never believed it at the start.

However, I am anxious regarding the next challenge in my life. Something I think for anyone who hasn’t had an eating disorder finds challenging anyway. That’s getting pregnant, becoming a parent. This is another area I think in medicine that doesn’t get spoken about or shared much. What happens when someone in recovery gets pregnant? Is it wise? Should O&G teams be aware? Do they ask or look for history of eating disorders?

I wanted to wait until I was solid into my recovery and even still I worry. I worry if the child will be small, pre-term, miscarry. Will I stay on track?

For my partner and me, having a family has been something we have always wanted. For reasons not related to my eating disorder, fertility is a difficult issue which I won’t go in to.

We are about to embark on IVF. This is something I haven’t entered into lightly, I’m all too aware of what’s required in the IVF process, the follicle stimulation, multiple hormones. This I’m sure is hard in a normal setting, but for those of us with significant body image issues to begin with, these issues need to be factored into planning. Hopefully help prepare the person for the changes and enable them to remain accountable. Support, hopefully can help to prevent slips.

Next issue, if we are fortunate enough to get pregnant… avoiding energy deficit. Some people experience nausea (both during fertility treatment and then in pregnancy). Hyperemesis gravidarum (aka morning sickness) this is not a good situation for someone with a restrictive eating disorder. Breast feeding post-partum.

Our bodies change throughout pregnancy. This is a fact. Something I am trying hard to prepare for. I feel going through the weight-restoration phase of recovery helps this, perhaps. My body has changed beyond any prior recognition and that’s ok, and I don’t even have a baby to care for and love. Or to explain my pregnant looking belly, aka recovery belly. I like to think that having a child will mean that none of the ‘HH’ thoughts will matter, because that child will be the most important, most amazing achievement I will ever have. But I wanted to share this because people with eating disorders go through pregnancy. It never gets spoken about and I don’t know whether we look for it in medicine. I think people could have help and support. I expect there are many people with eating disorders too afraid to share their struggle with the medical team, for fear of judgement, lack of understanding. What will I do?

Not really sure what the point of this post is, other than I’m happy to be here. I hope if you’re reading this and perhaps your treatment has just ended and you’re freaking out, or you’re starting recovery alone or with help, you can just know that there’s support available. Support doesn’t have to be formal or structured and remember celebrate the milestones. Navigating this is like an ultra-marathon but with no clear finish line.

Some online support groups and resources….

1. Beat eating disorders UK: https://www.google.co.nz/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwjxuaHD3a7tAhX2yDgGHUGiCXcQFjAAegQIAxAD&url=https%3A%2F%2Fwww.beateatingdisorders.org.uk%2Fsupport-services%2Fonline-groups&usg=AOvVaw2LpFetlZFjVyKJ6Sg1WWaX

2. Recovery warriors (Australia):eatingdisordersqueensland.org.au

3. Various options US: https://centerfordiscovery.com/groups/

4. EDANZ: New Zealand. Various resources. https://www.ed.org.nz/parent-carer-support-groups

SHOULD, is not a nice word..

Photo by Noelle Otto on Pexels.com

Should has no place in most daily language, but especially not in eating disorder recovery

Should implies rules, an obligation. That word is the reason I’m sat on my ass writing this. I was looking forward to going for a run, or joining my husband at boxfit tonight. However throughout the day at work I started to feel tired and that what I probably needed was to chill out with the cat.

Then that sneaky SHOULD word crept into the foreground. I heard my thoughts say “you should go tonight, you’ve not done anything all week”

That was the point I decided I will not exercise today. Exercise should be a priveledge/ pleasure, not a punishment.

This “SHOULD” demand was from my eating disorder, “HH” thinks I should exercise today, but that’s the very reason why not. A few months ago, I would have acted on this demand, the next day I would find it harder to eat or I’d feel more anxious about what I was eating.

Now I move my body because I want to, because it feels good, not because I feel I have to. The discomfort I used to feel if I missed a day of exercise was insurmountable before. I have to really listen to where the intent is from, whether it’s my voice, or ’HH’s.

I’m feeling proud, I can sit here and write this, instead of dragging my butt out to torture myself without enjoyment. Because I know when I truly want to move/ exercise it’s for me and not for the service of ‘HH’.

I have been a runner all my life. One of my favourite things even a a tiny child, before the days of my eating disorder was to go outside in the rain. As I got a bit older, if my athletics session was a wet session it was like Christmas for me! I loved the feel of the rain and being hot and the smell of it on the track or grass. Then ’HH’ showed up some years later. And my running, exercise was no longer for me, for the fun. It was all about targets, shifting goal posts that I would never be satisfied with.

It would be like the world ended if I had to miss a day, or I’d exercise when I was injured, sick and obviously that’s not fun. I’ve had to work really hard in my recovery to re-kindle my healthy relationship with movement, channeling that child who loved running in the rain and not the crazy person running in gale force winds/ all weathers all hours.

I took a period of abstinence, but not an extended period. I had a good support to help me workout where the intent was from. Some days I had meltdowns when I knew it wasn’t my healthy self and had to abstain. But doing that has got me here. If it feels wrong it is wrong. Exercise/movement is never meant to feel shameful, guilt driven (pre or post), like a chore. It’s a pleasure/ priveledge. Today was a day I know it was not for me, rather for ‘HH’. One day by continuing to listen to my healthy voice over and over, ‘HH’ won’t suggest I move when I don’t want to. The voice will be gone.

Challenge, Practice, Repeat…..Recover I hope.

Today was definitely helped by ‘Recovery Warriors” resources. Check out The Recovery Warriors app, website. They are currently holding a ‘holiday special” with lots of useful resources and videos etc. https://www.truewarrior.me/holiday-support

https://www.instagram.com/recovrywarriors/

Visit website
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Re-reading old journal entries, anorexia recovery. What language does your ED voice use?

Reframe negative eating disorder thoughts

I’ve been journaling for a long time. I was re-reading an old journal, one I started in early recovery. I found there was a theme to the language I used to describe how I was feeling, or when journalling about behaviours.

It was all self critical. Extremely negative.

Common words I used: ASHAMED, DISGUSTED, LONELY, ANGRY, FAT. This was even when I’d documented small positive steps to change.

“I feel ashamed, I want to crawl out of my skin, I feel trapped, consumed & powerless. I’m disgusted I’ve allowed myself to get into this predicament. I don’t feel I deserve the help. It’s a spell I cannot break no matter how hard I try I’m stuck”

This was an entry I made a few weeks into recovery.

Comparing this to more recent entries, there’s none of the negative language. It’s incredible how consuming our eating disorders are, they overshadow us, they thrive on secrecy and feed the feelings of isolation and shame grows and grows.

Now that I’m much further into recovery, I can seperate this unkind voice from my own, kinder, compassionate in built healthy self voice. I do not allow myself to use language such as ashamed, disgusted, instead I reframe them and ask myself what I’m needing. Why the ‘HH’ voice is spouting these terms. If I have a thought that sounds hypercritical I know it’s coming from ‘HH’ and not me, and serves no purpose in driving my recovery.

Self compassion is difficult in early recovery because we are listening to the negative thoughts. But as we grow stronger in recovery it’s easier to be kinder to ourselves. Something we have to re-learn to do. After being the opposite for so long. It feels uncomfortable. But anything in recovery that’s uncomfortable is good.

I found it hard to do NOTHING. Or pause have a cup of tea when I felt tired, or allow myself to feel emotions. But with time, one of my favourite pass times is to sit and literally do nothing with a cup of tea ( and most often a chocolate hobnob) Yes I am English and do believe this solves everything. I never thought that weekend early in recovery I would be able to to do that. I thought ‘HH’ would berate me for sitting for a second. Sure, there are days where I do hear the negative utterances. But the difference is now I don’t turn against myself, I don’t tell myself I’m ashamed of myself, not deserving etc. I tell myself I am worthy, I can live however I want and I don’t have to listen to the thoughts. I am not those thoughts. What thoughts do you need to re-frame?

Weight gain in eating disorder recovery

Recovery belly

For most of us recovery means committing to weight gain. Learning to accept our bodies unsuppressed natural weight. Getting there has for me been far harder than simply just putting on weight. It’s weight we were never meant to have lost, our bodies didn’t want us to lose this weight but learning to accept this doesn’t happen overnight. We taught it that losing weight feels good, gaining weight feels bad. We taught our brains to believe “skinny = happy” but we know this isn’t the truth. I was never more unhappy than when I was at my sickest. My emotions blunted, isolated from friends, family and bound by strict rules that my life revolved around. No I was not happy. I was a ghost.

But that doesn’t mean accepting weight gain was/ is easy. It’s going against everything I’ve taught myself to believe is ideal. The weight restoration phase on ED recovery is a small part but is so painful because of our neural pathways and our beliefs and distortions.

Weight restoration is messy. I think if no one has told you, now is a good time to tell you. When you gain weight after waging war against your body, your body no longer trusts you. Whether this is from diet cycling, restriction, purging or over exercising. Your body likes to be in homeostasis and sits at a steady weight when left to its own devices. But when we intervene everything slows down, the body has a massive freak out. It thinks its starving (which in many of our cases it literally is) and when we start eating again the body is like, oh thank fuck. It holds on to everything initially in case we are cruel enough to inflict war on it again. The most common place this extra weight/ fat goes to is the tummy a.k.a the “recovery belly”. You can easily look 6 months pregnant. I look pregnant now. Staving off unwanted comments can be an unwanted side effect. But if this happens it’s because you are recovering and doing well so don’t give in. This is hard. My belly has been here a while and likely It’s here to stay for a while yet. I have made peace with it, doesn’t mean I don’t freak out when I see it in reflections some days. Today has been a hard day. But I know it’s keeping me alive and acts as a reminder to not go backwards and the progress I’m making. I know it will redistribute and if it doesn’t well then I’ll learn accept that too. I did a lot of googling when I started my weight restoration journey and so I expect with time my body will trust me once more, so long as I am kind to it.

Doesn’t matter how much I hated how I looked at my sickest, I was still terrified of weight gain. I have had to and am working very hard on rewiring this fear. By challenging it every day. This has involved many melt downs, sobbing in the shower but it’s so much easier with time as your brain shifts with you. This takes a bit of time.

Ditch the scales..

Ditch the scales. They are not your friend. You should break up with this unloving/ non compassionate partner, it’s a one sided relationship. ( *There may be times where you have to be weighed for medical reasons) this does not mean YOU need to know your weight. If this scenario occurs request it to be blind, because no matter what the number, it will not serve your recovery but it will fuel your ED.

My relationship with the scales was messy, unforgiving. In my depths of my ED, I would live my days by the number in the morning. It would stipulate whether I was going to have a good day or bad day, whether I deserved to eat. I would weigh myself multiple times a day and go to great lengths to do it. In early recovery I used it as an excuse I was making progress. BULLSHIT, I was still using it as an excuse not to gain “too fast”, “too much” this is not recovery.

You do not need to deserve to eat. Eating is a necessity every one shares. Your weight does not define you. It is a number. It means nothing in relation to health, your worth. So ditch them. I binned mine. I have no idea what I weigh now. It’s not relevant because I am getting healthy. Sure in early recovery teams may need to know our weights. We do not. Be free and kind to yourself.

Ditch the things that are holding you back in ED recovery

Fitness trackers. These are not our friends in ED recovery. I do not think anyone with an ED history should EVER wear a fitness tracker watch etc. similarly to the scales my day revolves around steps, calories burned, moving raising my HR bla bla bla. Why would you need it unless training for an Olympic event? I don’t even really see the necessity for my patients because if they have problems with HR etc it’s monitored formally. So like my scales I binned my watch. It wasn’t easy but it will be liberating I assure you.

So I hope if this resonates you can make some changes and move forward. You deserve better. Your worth cannot be defined by a number.